Neuromuscular junction disorders can present in a variety of challenging ways, with the potential to mislead neurologists. Journal editors Prof. Philip Smith and Dr. Geraint Fuller begin with this subject as they talk through the latest issue Practical Neurology, for December 2024. The conversation moves to neck flexion and brain zaps, reflects on the undiminished importance of "general" neurology, and also touches on maternal epilepsy risks, frailty's impact on stroke patients, timely recognition of glaucoma, and sustainable practices for green physicians. To finish, there's the now-traditional recital of eponymous syndromes.

Read the issue: https://pn.bmj.com/content/24/6

Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol.

Production by Letícia Amorim and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening.

The immune system is a recurring feature in the cases discussed in this edition of the Case Reports podcast. The first paper details the cases of two young women, sisters, presenting with overlapping conditions but resulting in tragically different outcomes (1:16). Both were in their twenties, had given birth recently, and developed limb weakness along with several other neurological symptoms. https://pn.bmj.com/content/24/5/422

Our second case is a 72-yo woman with a range of symptoms including diplopia, ptosis, myalgia, and worsening shortness of breath (21:27). She had had surgical resection of a malignant melanoma, and was receiving immunotherapy treatment. Her presentation resembled myasthenia gravis, but initial treatment did not yield a response. https://pn.bmj.com/content/24/5/428

The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the June 2024 issue of the journal.

(1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.

Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. This episode was produced and edited by Brian O'Toole. Thank you for listening.

"Could this presenting syndrome be caused by a neurotoxin?"

Oftentimes neurologists will pass over toxins when diagnosing. Yet disease caused by neurotoxins is widespread, with many having quite typical syndromes. In the studio to discuss this is the first author of the October 2024 Editors' Choice paper, Dr. Frederick Vonberg¹. He draws attention to some hobbies and occupations to watch out for, the global prevalence of lead poisoning, presentations of botulism, and the origin of the infamous Mad Hatter syndrome.

Read the paper:

Neurotoxicology: a clinical systems-based review

1. National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest episodes. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol.

This episode was hosted by PN's podcast editor Dr. Amy Ross Russell. Production by Letícia Amorim, Brian O'Toole, and Amy Ross Russell. Editing by Brian O'Toole.